Abstract
Patient, male, 33 years old, with a history of dyspnea on exertion for more than 10 years and chest pain for one month. Physical examination: Blood pressure 151/57 mmHg, heart rate 87 beats per minute, irregular rhythm, a Grade III/VI systolic murmur heard in the precordium. Electrocardiogram showed fragmented QRS complexes in the inferior leads and clockwise rotation.
Upon admission, the initial transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) revealed left ventricular enlargement, diffuse aneurysmal dilatation of the right coronary artery (RCA) with a maximum diameter of approximately 38 mm. A fistula with a diameter of about 10 mm was observed in the basal segment of the left ventricular inferior wall, connecting to the aneurysmal RCA. Color Doppler flow imaging (CDFI) demonstrated a significant diastolic multicolored flow jet originating from the fistula, with a velocity of 2.1 m/s and a pressure gradient of 18 mmHg. The ejection fraction (EF) was measured at 65%(Fig.1). The ultrasound diagnosis suggested right coronary artery aneurysm with right coronary artery-to-left ventricle fistula (RCALVF).